Antonios Panagiotopoulos

Treatment of cutaneous leishmaniasis with cryosurgery

Background  The management of cutaneous leishmaniasis with topical methods, if effective, can spare patients from long and costly inpatient treatments.

Comparison of cryotherapy to imiquimod 5% in the treatment of anogenital warts.

Summary The aim of this study was to compare the efficacy of crotherapy versus imiquimod 5% in the treatment of anogenital warts. Eighty HIV-negative males were included in the analysis; 35 of them were treated with imiquimod 5% three times a week for 6–10 hours and 45 of them with cryotherapy once in three weeks. Follow-up appointments were arranged every month for the first three months and then at six and 12 months, or in between whenever the patients noticed any signs of recurrence. Treatment for both groups was continued for a total of 12 weeks or until the warts cleared. At the end of three months, irrespective of the type of treatment, 78.8% of the patients demonstrated 100% improvement. Cryotherapy was more effective, as 86.7% of patients showed 100% improvement compared with 68.6% of patients in the imiquimod group. On the contrary, 17.1% of the imiquimod group did not show any signs of improvement, compared with 2.2% of the cryotherapy group (P = 0.017). However, patients treated with imiquimod tended to improve earlier than patients on cryotherapy (P = 0.012). No statistically significant difference was observed regarding the recurrence rate between the two groups (P = 0.138). Treatment with imiquimod was less painful than cryotherapy (P = 0.034). Cryotherapy was more effective than imiquimod 5% for the treatment of anogenital warts in males but was more inconvenient.

Assessment of Cryotherapy for the Treatment of Verrucous Epidermal Naevi

Epidermal naevi are hamartomas that are characterized by hyperplasia of the epidermis and adnexal structures and may be associated with serious disfiguration. Management of epidermal naevi is challenging. We present here our experience with cryosurgery in the treatment of verrucous epidermal naevi. The aim of this study was to determine the efficacy and safety of cryosurgery for the treatment of epidermal naevi. Nine patients with verrucous epidermal naevi and two with extensive unilateral epidermal naevus were treated with cryosurgery. Two cycles of open spray technique were used, 10-15 sec each, depending on the size and extent of the naevus. Ten patients had their naevi treated successfully in 2-5 sessions with two cycles of therapy, and the cosmetic result was excellent with no scarring. One patient showed a relapse within 8 months after the treatment. One patient with phototype IV developed hypochromic scarring, but repigmentation occurred after 6 months. Postoperative healing time was 10-20 days. Cryosurgery is an extremely effective therapeutic modality for the treatment of epidermal naevi. The low cost, the simplicity of the technique and the good cosmetic result makes cryosurgery an excellent therapeutic modality for the treatment of epidermal naevus.

Molluscum contagiosum and cryosurgery: Triggering factors for wells' syndrome?

Sir, Wells’ syndrome, or eosinophilic cellulitis, is an uncommon inflammatory dermatosis characterized in most cases by skin lesions resembling cellulitis and peripheral eosinophilia (1, 2). Patients rarely have systemic symptoms (3). The cutaneous manifestations include localized oedema and infiltrated erythematous plaques, infrequently studded with vesicles or bullae. Occasionally, less inflammatory lesions, such as multiple annular or circinate erythematous plaques with indurated borders, may be seen (4). The disease is nonscarring, leaving a slowly resolving hyperpigmentation. The cause of Well’s syndrome is unknown. We want to report a case where the syndrome started after a viral infection (molluscum contagiosum) treated repeatedly with cryosurgery.

Coexistence of Psoriasis and Pemphigus after Enalapril Intake

Letters to Dermatology 10 Stege H, Schöpf T, Ruzicka T, Krutmann J: High-dose UVA1 for urticaria pigmentosa. Lancet 1996;347:64. 11 Breuckmann F, von Kobyletzki G, Avermaete A, Pieck C, Kreuter A, Brockmeyer NH, Altmeyer P, Gambichler T: Mononuclear cells in atopic dermatitis in vivo: Immunomodulation of the cutaneous infiltrate by medium-dose UVA1 phototherapy. Eur J Med Res 2002;7:315–322. 12 Kroenauer C, Eberlein-Koenig B, Ring J, Behrendt H: Inhibition of histamine release of human basophils and mast cells in vitro by ultraviolet A (UVA) irradiation. Inflamm Res 2001;50:44–46.

Treatment of widespread cutaneous larva migrans with thiabendazole

Cutaneous larva migrans (CLM) is a characteristic eruption that is caused by penetration and migration in the skin of nematode larvae. Both animal and human hookworms have been implicated in the pathogenesis of the condition, with Ancylostoma braziliensis and A. caninum being the most common among them. CLM is quite common in tropical areas, but, due to travelling, several cases have also been described in Europe. We present a patient with CLM who presumably contacted the disease during a holiday in Singapore. The patient was treated successfully with oral thiabendazole.

Prognostic factors for the response to treatment in males with genital warts

Background  Factors predicting an unfavourable course of genital warts to treatment have not been determined.